Background

Currently there are multiple surgical interventions utilized in the treatment of adult obstructive sleep apnoea (OSA). Amongst these, maxillomandibular advancement (MMA) has been shown to improve pharyngeal and hypopharyngeal airway by physically expanding the skeletal structure. Despite this, the role of MMA in the treatment of OSA has remained controversial due to associated morbidity and debate surrounding its clinical efficacy.

Objectives

The aim of this study was to assess the effectiveness of MMA as a surgical treatment alternative for OSA, examine predictors of surgical success, and suggest a protocol for the surgical management of OSA in a multidisciplinary setting.

Methods

A retrospective clinical audit was conducted of all patients who presented to the Oral & Maxillofacial Surgery Unit of the Royal Adelaide Hospital for management of OSA via referral by a sleep disorder clinic, over a period of 4.5 years (from 1 January 2010 to 30 June 2014). Demographic data such as age, gender, body mass index (BMI) and medical comorbidity were collected and reviewed alongside the respective treatment modality undertaken. Four surgical cases undergoing MMA were identified and examined to determine treatment efficacy and associated surgical morbidity.

Principal Findings

Pre- and post-operative polysomnography, including mean respiratory distress indices (RDI) and nadir oxyhemoglobin desaturation, and cephalometric analysis were evaluated for those cases identified as having undergone MMA. Other therapeutic factors, such as previous or concurrent surgery, degree of maxillomandibular advancement and surgical morbidity were also considered. In addition, effects on sleepiness and quality-of-life measures were reviewed to assess clinical outcome.

Conclusion

MMA is a safe and effective treatment for OSA. However, there needs to be careful case selection and peri-operative care within a multidisciplinary setting to minimise surgical morbidity.